Provider Demographics
NPI:1093073082
Name:PATEL, SAMIR G (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:G
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:
Practice Address - Street 1:101 BANKS STA
Practice Address - Street 2:KAISER PERMANENTE FAYETT MEDICAL OFFICE
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7507
Practice Address - Country:US
Practice Address - Phone:678-610-3700
Practice Address - Fax:770-838-8922
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
GA073244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program